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Herefordshire & Worcestershire
Medicines and Prescribing Committee
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
 note 

Hypnotics should not generally be prescribed on discharge  unless taken regularly prior to admission.

Melatonin Modified-Release Tablets (Circadin ®)
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Formulary
Amber with Shared Care

  • Approved for the treatment of sleep disorders in children and adults associated with neurological and/or behavioural problems, including ADHD and autism, and in older adults with dementia where alternative hypnotics have failed.

  • Treatment should be specialist-initiated with transfer to primary care under shared care if specialist and GP in agreement.

 
 
04.01.01  Benzodiazepines
Nitrazepam
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Formulary
Green
 
 
Controlled Drug Temazepam
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Formulary
Green
 
 
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zaleplon
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Formulary
Green

In Line With NICE TA77

 
Link  NICE TA77 - Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia
 
Zolpidem Tartrate Tablets
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Formulary
Green

In Line With NICE TA77

 
Link  NICE TA77 - Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia
 
Zopiclone Tablets
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Formulary
Green

In Line With NICE TA77

 
Link  NICE TA77 - Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia
 
04.01.01  Chloral and derivatives to top
Chloral Hydrate Elixir (Chloral Elixir®)
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Formulary
Amber

  • Many strengths are unlicensed "Specials"

  • Preferred preparation is licensed chloral hydrate 143.3mg/5ml (Welldorm) elixir.

 
 
04.01.01  Clomethiazole (Chlormethiazole)
Clomethiazole
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Formulary
Green
 
 
04.01.01  Antihistamines
Promethazine Hydrochloride
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Formulary
Green
 
 
04.01.01  Alcohol
04.01.01  Sodium oxybate
04.01.02  Anxiolytics to top
04.01.02  Benzodiazepines
Diazepam
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Formulary
Green
 
 
Lorazepam
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Formulary
Green
 
 
Oxazepam
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Formulary
Green
 
 
04.01.02  Buspirone
Buspirone Hydrochloride
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Restricted Drug Restricted
Amber

Consultant Psychiatrist initiation only

 
 
04.01.02  Beta blockers
 note  Beta-blockers (section 2.4 of BNF) do not affect psychological symptoms of anxiety, such as worry, tension, and fear, but they do reduce autonomic symptoms, such as palpitation and tremor; they do not reduce non-autonomic symptoms, such as muscle tension. Beta-blockers are therefore indicated for patients with predominantly somatic symptoms; this, in turn, may prevent the onset of worry and fear.
Propranolol
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Formulary
Green
 
 
04.01.02  Meprobamate
04.01.03  Barbiturates to top
04.02  Drugs used in psychoses and related disorders
04.02.01  Antipsychotic Drugs
 note  Other antipsychotic drugs may be available at the request of Consultant Psychiatrist
Benperidol
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Formulary
Amber
 
 
Chlorpromazine Hydrochloride
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Formulary
Green
 
 
Flupentixol
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Formulary
Green
 
 
Haloperidol
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Formulary
Green
 
 
Levomepromazine Injection
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Restricted Drug Restricted
Green

Palliative Care

 
 
Pericyazine
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Formulary
Amber
 
 
Promazine Hydrochloride
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Formulary
Green
 
 
Sulpiride
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Formulary
Amber
 
 
Trifluoperazine
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Formulary
Green
 
 
Zuclopenthixol Acetate Injection
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Formulary
Red
 
 
Zuclopenthixol Dihydrochloride Tablets
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Formulary
Green
 
 
04.02.01  Atypical Antipsychotics
Amisulpride
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Formulary
Amber

In Line With NICE CG178 (Replaces TA43)

 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
 
Aripiprazole Tablets
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Formulary
Amber

In Line With NICE TA213
Schizophrenia in people aged 15 to 17 years who are intolerant of resperidone, or for who risperidone is contraindicated, or whose schizophrenia has not been adequately controlled with risperidone

In Line With Nice TA292
Aripiprazole as a possible treatment (for up to 12 weeks) for moderate to severe manic episodes in young people aged 13 and older with bipolar I disorder.

 
Link  NICE TA213: Schizophrenia - aripiprazole
Link  NICE TA292 - Aged 13 and older with bipolar I disorder.
 
Clozapine
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Restricted Drug Restricted
Red

Consultant Psychiatrist initiation / secondary care prescribing only. Not for prescribing in primary care.

 
Link  Drug Safety Update (Aug 20): Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
 
Olanzapine Tablets and orodispersible tablets
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Formulary
Amber

In Line With NICE CG185 and CG178 (Replaces TA43).

Oral lyophilisates sugar free tablets are not included in the formulary as they are  substantially more expensive.

 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
Link  NICE CG185 - Bipolar disorder: assessment and management
 
Quetiapine
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Formulary
Amber

In Line With NICE CG178 (Replaces TA43)

 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
 
Quetiapine Modified Release
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Formulary
Amber

In Line With NICE CG178 (Replaces TA43)

If a modified release preparation is required, then preferred brands are:

    • Sondate® XL (1st line choice)
    • Mintreleq®
    • Biquelle® XL

 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
 
Risperidone
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Formulary
Amber

In Line With NICE CG178 (Replaces TA43)

 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
 
Olanzapine Long Acting Injection (Zypadhera®)
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Formulary
Red
 
Link  NICE CG178 - Psychosis and schizophrenia in adults: prevention and management
 
04.02.02  Antipsychotic depot injections
Aripiprazole long acting injection
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Restricted Drug Restricted
Red

For the maintenance treatment of schizophrenia in adult patients stabilised with oral aripiprazole in line with the WHCT Antipsychotic Long-Acting Injection (Depot) Choice Pathway; for secondary care prescribing only, i.e. not for primary care prescribing, with an annual audit requested.

 
 
Flupentixol Decanoate (Depixol® Conc.)
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Formulary
Amber
 
 
Flupentixol Decanoate (Depixol® Low Volume)
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Formulary
Amber
 
 
Fluphenazine Decanoate (Modecate®)
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Formulary
Amber
 
 
Haloperidol (Haldol Decanoate®)
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Formulary
Amber
 
 
Paliperidone 3 monthly injection (Trevicta®)
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Formulary
Amber

PRESCRIBE BY BRAND


For the maintenance treatment of schizophrenia in adult patients who are clinically stable on (formulary) monthly paliperidone palmitate injectable product (Xeplion®).




 
 
Paliperidone monthly injection (Xeplion®)
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Formulary
Amber

 PRESCRIBE BY BRAND

 
 
Risperidone (Risperdal Consta®)
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Formulary
Amber

In Line With NICE CG82 (Replaces TA43)

 
Link  NICE CG82 - Psychosis and schizophrenia: management
 
Zuclopenthixol Decanoate (Clopixol®)
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Formulary
Amber
 
 
Zuclopenthixol Decanoate (Clopixol® Conc.)
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Formulary
Amber
 
 
04.02.03  Antimanic drugs to top
04.02.03  Benzodiazepines
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine
04.02.03  Valproic acid
Valproic Acid (Depakote®)
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Restricted Drug Restricted
Amber with Shared Care

  • Only through specialist initiation and annual review

  • As valproate semisodium

 
Link  Drug Safety Update (Feb 20): Valproate (Epilim▼, Depakote▼) pregnancy prevention programme: updated educational materials
Link  March19: Guidance Document on Valproate Use in Women and Girls of Childbearing Years (V1)
Link  MHRA NHS IMPROVEMENT PATIENT SAFETY ALERT (Apr 2017): Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures
 
04.02.03  Lithium to top
 note 

See Shared Care Guideline.

Lithium should always be prescribed by brand name as different preparations may vary in bioavailability; changing the preparation requires the same precautions as initiation of treatment


A lithium treatment pack may be given to patients on initiation of treatment. The pack consists of a patient information booklet, lithium alert card, and a record book for tracking serum-lithium concentration. Packs may be purchased from 3M.
Tel: 0845 610 1112
Email: nhsforms@spsl.uk.com

Lithium Carbonate (Camcolit®)
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Formulary
Amber with Shared Care
 
 
Lithium Carbonate Modified-Release Tablets (Priadel®)
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Formulary
Amber with Shared Care
 
 
Lithium Citrate Liquid (Priadel®)
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Formulary
Amber with Shared Care
 
 
04.03  Antidepressant drugs
Controlled Drug Pregabalin
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Formulary
Green
 
Link  Generalised Anxiety Disorder (GAD) - Pharmacological Management
 
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
Imipramine Hydrochloride
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Formulary
Green
 
 
Lofepramine
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Formulary
Green
 
 
Nortriptyline
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Formulary
Green
 
 
04.03.01  Related antidepressants
Trazodone Hydrochloride
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Formulary
Amber
 
 
04.03.02  Monoamine-oxidase inhibitors to top
04.03.02  Reversible MAOI's
Moclobemide
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Formulary
Green
 
 
04.03.03  Selective serotonin re-uptake inhibitors
Citalopram
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Formulary
Green

  • Tablets and oral drops.

  • See Guidance re dose dependent QT prolongation.

  • Note: 4 drops (8 mg) is equivalent in therapeutic effect to 10mg tablet. Mix with water, orange juice, or apple juice before taking


 
Link  MHRA Drug Safety Update (Jul 16): Citalopram: suspected drug interaction with cocaine; prescribers should consider enquiring about illicit drug use
 
Escitalopram
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Formulary
Green
 
 
Fluoxetine
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Formulary
Green

  • Capsules, dispersible tablets, and oral solution.

  • (N.B. Dispersible tablets are more cost effective than the oral solution)

 
 
Paroxetine
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Formulary
Green
 
 
Sertraline
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Formulary
Green
 
 
04.03.04  Other antidepressant drugs
 note  Not for first line use.
Duloxetine  (Cymbalta®)
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Formulary
Green

Step 3 for diabetic neuropathy - discontinue if inadequate response after 2 months.

 
 
Mirtazapine
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Formulary
Green
 
 
Venlafaxine
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Formulary
Green
 
 
Venlafaxine modified-release
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Formulary
Green

First choice should be a non modified-release preparation but where a modified release preparation is required Vensir® XL capsules should be the first choice modified release preparation.


Venlalic® XL tablets available if an alternative product is required e.g. due to availability issues.

 
 
Vortioxetine
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Formulary
Amber

In line with NICE TA367
 

 
Link  NICE TA367 Vortioxetine for treating major depressive episodes
 
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate Hydrochloride MR caps
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Formulary
Amber with Shared Care

PRESCRIBE BY BRAND



  • Brands include Medikinet® and Equasym®

 
 
Controlled Drug Methylphenidate Hydrochloride MR tabs
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Formulary
Amber with Shared Care

PRESCRIBE BY BRAND



  • Product of choice - Xaggitin® XL 

  • Other brands include: Concerta XL® and Matoride XL®

  • NB. Concerta XL® & Xaggitin XL® are bioequivalent and can be interchanged.

 
 
Controlled Drug Dexamfetamine Sulphate
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Restricted Drug Restricted
Amber with Shared Care
 
 
Controlled Drug Guanfacine
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Restricted Drug Restricted
Amber with Shared Care

  • Consultant initiation only. 

  • In Line with local shared pathway.

  • M/R tablets 1mg/2mg/3mg/4mg

 
 
Controlled Drug Lisdexamfetamine
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Restricted Drug Restricted
Amber with Shared Care

  • Consultant initiation only. 

  • In Line with local shared pathway.

 
 
Modafinil
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Restricted Drug Restricted
Amber

In line with licensed indication:


"Modafinil is indicated in adults for the treatment of excessive sleepiness associated with narcolepsy with or without cataplexy."

 
 
Atomoxetine
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Restricted Drug Restricted
Amber with Shared Care

  • Consultant initiation only. 

  • In Line with local shared pathway.

 
 
04.04  Cocaine to top
04.05  Drugs used in the treatment of obesity
04.05.01  Anti-obesity drugs acting on the gastro-intestingal tract
Orlistat
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Formulary
Green

NICE Pathway

 
 
04.05.02  Centrally acting appetite suppressants
04.06  Drugs used in nausea and vertigo
04.06  Vomiting during pregnancy to top
04.06  Postoperative nausea and vomiting
04.06  Motion sickness
04.06  Other vestibular disorders
04.06  Cytotoxic chemotherapy
04.06  Palliative care to top
04.06  Migraine
04.06  Antihistamines
Cinnarizine Tablets
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Formulary
Green
 
 
Cyclizine Tablets & Injections
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Formulary
Green
 
 
Promethazine Hydrochloride Injection
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Formulary
Green
 
 
Promethazine Teoclate
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Restricted Drug Restricted
Amber

For hyperemesis gravidarum

 
 
04.06  Phenothiazines and related drugs
Prochlorperazine
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Formulary
Green
 
 
04.06  Domperidone and metoclopramide
Metoclopramide Hydrochloride
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Formulary
Green

Note: Not for use in patients under 20 years old

 
Link  MHRA Drug Safety Update (August 2013): Metoclopramide - risk of neurological adverse effects, restricted dose and duration of use
 
Domperidone
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Restricted Drug Restricted
Green

Domperidone is now contraindicated in people:




    • With conditions where cardiac conduction is, or could be, impaired

    • With underlying cardiac diseases such as congestive heart failure

    • Receiving other medications known to prolong QT interval or potent CYP3A4 inhibitors

    • With severe hepatic impairment



 


 MHRA/CHM advice (updated December 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

 
Link  Drug Safety Update (Dec 19): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
 
04.06  5HT3 antagonists to top
Granisetron
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Formulary
Red
 
 
Ondansetron
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Formulary
Green
 
Link  Drug Safety Update (Jan 20): Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy
 
Palonosetron with netupitant  (Akynzeo®)
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Formulary
Red
 
 
04.06  Neurokinin receptor antagonist
Aprepitant
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Restricted Drug Restricted
Red

Prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy after failure of first line anti-emetic options.

 
 
04.06  Cannabinoid
Nabilone
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Restricted Drug Restricted
Red

As an anti-emetic during systemic anti-cancer therapy if unresponsive to conventional treatments; in line with Network/Trust guidelines (WAHT MSC Aug 2020)

 
 
04.06  Hyoscine
04.06  Other drugs for Ménière's disease
Betahistine Dihydrochloride Tablets
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Formulary
Green
 
 
04.07  Analgesics to top
04.07.01  Non-opioid analgesics and compound analgesic preparations
Aspirin Tablets (Dispersible 300mg)
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Formulary
Green

  • Available over the counter for some conditions.

  • Consider self care.

 
 
Nefopam Hydrochloride
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Formulary
Green

Tablets and injection

 
 
Paracetamol
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Formulary
Green

  • Availble over the counter.

  • Consider self care.

 
 
04.07.01  Compound analgesic preparations
 note  Paracetamol and codeine should be prescribed separately if possible.
Paracetamol and codeine (Co-codamol® 30/500)
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Formulary
Green




 
 
Paracetamol and codeine (Co-codamol® 8/500)
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Formulary
Green
 
 
Paracetamol and dihydrocodeine (Co-dydramol®)
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Formulary
Green
 
Link  MHRA Drug Safety Update (Jan 18): Co-dydramol: prescribe and dispense by strength to minimise risk of medication error
 
04.07.02  Opioid analgesics
 note 

Prescription requirements
Prescriptions for Controlled Drugs that are subject to prescription requirements(1) must be indelible,(2) and must be signed by the prescriber, be dated, and specify the prescriber’s address. The prescription must always state:

  • the name and address of the patient;
  • in the case of a preparation, the form(3) and where appropriate the strength(4) of the preparation;
  • either the total quantity (in both words and figures) of the preparation,(5) or the number (in both words and figures) of dosage units, as appropriate, to be supplied;
  • in any other case, the total quantity (in both words and figures) of the Controlled Drug to be supplied;
  • the dose;(6)
  • the words ‘for dental treatment only’ if issued by a dentist.


(1)All preparations in Schedules 2 and 3, except temazepam.
(2)A machine-written prescription is acceptable. The prescriber’s signature must be handwritten.
(3)The dosage form (e.g. tablets) must be included on a Controlled Drugs prescription irrespective of whether it is implicit in the proprietary name (e.g. MST Continus) or whether only one form is available.
(4)When more than one strength of a preparation exists the strength required must be specified.
(5)The Home Office has advised that quantities of liquid preparations, such as methadone oral solution, should be written in millilitres.
(6)The instruction ‘one as directed’ constitutes a dose but ‘as directed’ does not.
(7)The prescriber may forward-date the prescription; the start date may also be specified in the body of the prescription.

Dihydrocodeine
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Formulary
Green
 
 
Controlled Drug Morphine Sulfate (standard release) tablets (Sevredol®)
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Formulary
Green

  • PRESCRIBE BY BRAND

  • Sevredol® is the standard release morphine sulfate preparation of choice.

  • Sevredol is a standard preparation and required to be prescribed solely by brand across the Herefordshire & Worcestershire Health Economy.

 
 
Morphine Sulfate 10mg/5mL oral solution (Oramorph®)
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Formulary
Green

  • PRESCRIBE BY BRAND

  • Standardisation of opioid products is required to be prescribed solely by brand across the Herefordshire and Worcestershire Health Economy.

 
 
Controlled Drug Morphine Sulfate modified release capsules
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Formulary
Green

  • PRESCRIBE BY BRAND

  • Zomorph® is the brand of choice for modified release morphine sulfate.

  • Standardisation of opioid products is required to be prescribed solely by brand across the Herefordshire and Worcestershire Health Economy.

 
 
Controlled Drug Pethidine Hydrochloride
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Formulary
Green
 
 
Controlled Drug Buprenorphine patches (twice weekly) (Bupease®)
(35mcg/hr, 52.5mcg/hr, 70mcg/hr)
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Restricted Drug Restricted
Green

  • PRESCRIBE BY BRAND

  • For use in palliative care only where patients unable to swallow.

  • Bupeaze® is the more cost effective preparation in primary care.

  • Remove after no longer than 96 hours.


 

 
 
Controlled Drug Buprenorphine patches (twice weekly) (Hapoctasin®)
(35mcg/hr, 52.5mcg/hr, 70mcg/hr)
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Restricted Drug Restricted
Green

  • PRESCRIBE BY BRAND

  • For use in palliative care only where patients unable to swallow.

  • Hapoctasin® is the more cost effective preparation in primary care

  • Remove after no longer than 72 hours.

 
 
Controlled Drug Buprenorphine patches (weekly)  (Butec®)
(5mcg/hr, 10mcg/hr, 15mcg/hr, 20mcg/hr )
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Restricted Drug Restricted
Green

  • PRESCRIBE BY BRAND

  • In palliative care for patients unable to swallow.

  • Butec® is the most cost effective preparation in Primary Care.After a dose of 15 micrograms/hour it would be cost effective to consider a change to low dose fentanyl patches.
     



 

 
Link  Dementia - Pain Prescribing Pathway
 
Controlled Drug Buprenorphine Tablets
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Formulary
Green

  • For analgesia.

 
 
Controlled Drug Codeine Phosphate
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Formulary
Green

Tablets and injection


 
 
Controlled Drug Diamorphine Hydrochloride Injection
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Formulary
Green

  • For palliative care

 
 
Controlled Drug Fentanyl (Abstral®)
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Restricted Drug Restricted
Red

Approved for initiation and ongoing prescribing by palliative care clinicians ONLY.

 
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
 
Controlled Drug Fentanyl (Actiq®)
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Restricted Drug Restricted
Red

Approved for initiation and ongoing prescribing by palliative care clinicians ONLY.

 
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
 
Controlled Drug Fentanyl (Effentora®)
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Restricted Drug Restricted
Red

Approved for initiation and ongoing prescribing by palliative care clinicians ONLY.

 
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
 
Controlled Drug Fentanyl (Instanyl®)
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Restricted Drug Restricted
Red

Approved for initiation and ongoing prescribing by palliative care clinicians ONLY.

 
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
 
Controlled Drug Fentanyl Patches
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Restricted Drug Restricted
Green

  • PRESCRIBE BY BRAND

  • Matrifen® is the brand of choice.

  • For patients unable to tolerate or swallow strong oral opioid morphine preparations.

  • Standardisation of opioid products is required to be prescribed solely by brand across the Herefordshire and Worcestershire Health Economy.
     




Occasionally some problems have been identified with adhesion of the patch with certain patients, although it is not obvious why. For these patients Fencino® is available as a second line option.
Durogesic DTrans® are also available as a third choice.


 
Link  Drug Safety Update (Sept 20): Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients
Link  MHRA Drug Safety Update (Oct 18): Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
 
Meptazinol Injection
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Restricted Drug Restricted
Red

Obstetrics use only

 
 
Controlled Drug Methadone Hydrochloride
(Analgesia)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
 
Controlled Drug Morphine Sulfate suspension (= sachet of granules to mix with water) (MST Continus®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Available on the formulary for Percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube administration ONLY

 
 
Controlled Drug Oxycodone hydrochloride modified-release tablets
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Second line option after morphine


PRESCRIBE BY BRAND
 


 

 
 
Controlled Drug Oxycodone hydrochloride standard-release
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Second line option after morphine
 
PRESCRIBE BY BRAND

 
 
Controlled Drug Oxycodone injection
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Second line option after morphine

 
 
Controlled Drug Oxycodone oral solution
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

Second line option after morphine

 
 
Controlled Drug Tramadol Hydrochloride SR
View adult BNF View SPC online View childrens BNF
Formulary
Green

Use non modified release preparation as first choice 


Preferred brands - Tramulief® and Marol®

 
 
Controlled Drug Tramadol Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules

 
 
04.07.03  Neuropathic pain
Amitriptyline Tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Controlled Drug Gabapentin Capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

For Step 2 use in neuropathic pain. 

 
 
Controlled Drug Ketamine (Oral Solution)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Palliative Care Use ONLY

 
Link  Ketamine Shared Care
 
Controlled Drug Pregabalin Capsules
View adult BNF View SPC online View childrens BNF
Formulary
Green

For Step 2 use in neuropathic pain
 

 
Link  Advice for prescribers on the risk of misuse of pregabalin and gabapentin
 
04.07.03  Trigeminal neuralgia to top
Carbamazepine Tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

Trigeminal neuralgia only

 
 
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs
04.07.04.01  Treatment of the acute migraine attack
04.07.04.01  Analgesics
04.07.04.01  5HT1 agonists to top
Sumatriptan
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Zolmitriptan
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
04.07.04.01  Ergot alkaloids
04.07.04.01  Anti-emetics
04.07.04.01  Other drugs for migrane
04.07.04.02  Prophylaxis of migraine
Clonidine Hydrochloride Tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Pizotifen
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
04.07.04.03  Cluster headache to top
04.08  Antiepileptics
04.08.01  Control of epilepsy
Brivaracetam
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Brivaracetam requires specialist initiation by a Consultant Neurologist with appropriate experience in the treatment of epilepsy/Epilepsy CNS prescriber. The initiating consultant/Epilepsy CNS will continue to prescribe brivaracetam until the patient has been reviewed and stabilisation of the patient's dose and condition has been achieved; maintenance prescribing may be requested from GPs whilst giving any supportive monitoring guidance.


MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
Lacosamide
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
Perampanel
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
Retigabine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In line with NICE TA232.
 
MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
Link  NICE TA232 Retigabine for the adjunctive treatment of partial onset seizures in epilepsy
 
04.08.01  Partial seizures with or without secondary generalisation
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine to top
Carbamazepine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children).


PRESCRIBE BY BRAND - Tegretol is the preferred brand.



MHRA Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product 
 

 
 
Eslicarbazepine acetate
View adult BNF View SPC online View childrens BNF
Formulary
Amber with Shared Care

Following tertiary provider consultant recommendation in line with provider Shared Care Agreement.
 
MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
Oxcarbazepine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children)

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
04.08.01  Ethosuximide
Ethosuximide
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (Adults) or Initiation (children).
 
MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
04.08.01  Gabapentin and pregabalin
Controlled Drug Gabapentin
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children)

MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
Controlled Drug Pregabalin
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
04.08.01  Lamotrigine
Lamotrigine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children)

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
04.08.01  Levetiracetam
Levetiracetam
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children).
 
MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
Link  MHRA Drug Safety Update (Jan 17): levetiracetam (Keppra) 100 mg/mL: risk of medication errors
 
04.08.01  Phenobarbital and other barbiturates to top
Controlled Drug Phenobarbital (phenobarbitone)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

PRESCRIBE BY BRAND
 
MHRA Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product.

 
 
04.08.01  Phenytoin
Phenytoin
View adult BNF View SPC online View childrens BNF
Formulary
Amber

PRESCRIBE BY BRAND
 
MHRA Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product 



Note: Dose adjustment necessary when changing formulations

 
 
04.08.01  Tiagabine
Tiagabine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
04.08.01  Topiramate
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist recommendation (for adults) or specialist initiation(for children).

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history.

 
 
04.08.01  Valproate
Sodium Valproate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Only through specialist initiation and specialist annual review

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
Link  Drug Safety Update (Feb 20): Valproate (Epilim▼, Depakote▼) pregnancy prevention programme: updated educational materials
Link  March 19: Guidance Document on Valproate Use in Women and Girls of Childbearing Years (V1)
Link  MHRA NHS IMPROVEMENT PATIENT SAFETY ALERT (Apr 2017): Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures
 
04.08.01  Vigabatrin to top
Vigabatrin
View adult BNF View SPC online View childrens BNF
Formulary
Amber with Shared Care

For use in Paediatrics
 
Supported with a ESCA

MHRA Category 3 - It is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

 
 
04.08.01  Zonisamide
Zonisamide
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
04.08.01  Benzodiazepines
Clobazam
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist recommendation(adults) or initiation(children)

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
Clonazepam Tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber

For specialist recommendation (Adults) or initiation (Children).


MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
 
04.08.01  Other Drugs
04.08.02  Drugs used in status epilepticus
Clonazepam Injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Diazepam
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection and rectal solution

 
 
Lorazepam Injection
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Controlled Drug Midazolam Buccal
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation.


PRESCRIBE BY BRAND - Buccolam® is the preferred brand


Buccolam® and Epistatus® are not interchangeable and there is high risk of harm if patients receive the incorrect brand and strength of buccal midazolam.

 
 
Paraldehyde Enema
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Phenytoin Sodium (Epanutin® Ready Mixed Parenteral)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Phenytoin Sodium Injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
04.08.03  Febrile convulsions to top
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease
Ropinirole modified release
View adult BNF View SPC online View childrens BNF
Formulary
Amber

For specialist initiation only
Primary care - prescibe by brand name REPINEX XL

 
 
04.09.01  Dopamine receptor agonists
Apomorphine Hydrochloride (APO-go®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber with Shared Care

Consultant initiation only - may be continued by GP in line with Shared Care Guideline

 
Link  MHRA Drug Safety Update (April 2016): Apomorphine with domperidone: minimising risk of cardiac side effects
 
Bromocriptine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation only 


Note: Ergot-derived dopamine receptor agonists have been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions. 

 
 
Cabergoline
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation only 


Note: Ergot-derived dopamine receptor agonists have been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions.

 
 
Pergolide
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation only 


Note: Ergot-derived dopamine receptor agonists have been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions. 

 
 
Pramipexole
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation only

Preferred modified release brand is Pipexus®
 

 
 
Ropinirole
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation only
 

 
 
Rotigotine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In PD specialist initiation 
 
In Restless Leg Syndrome consultant recommendation only in patients with severe RLS where treatment with pramipexole and ropinirole has failed.

 
 
04.09.01  Levodopa
Co-Beneldopa (Madopar®CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Co-Beneldopa (Madopar®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Co-Careldopa (Half Sinemet ®CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

25/100 (carbidopa 25 mg & levodopa 100 mg) modified-release capsule


Specialist initiation

 
 
Co-Careldopa (Sinemet®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Co-Careldopa (Sinemet® CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

50/200 (carbidopa 50 mg & levodopa 200 mg)


Specialist initiation

 
 
Co-Careldopa and Entacapone (Stanek®; Sastravi®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation


Sastravi® and Stanek® are the formulary brands of choice.

 
 
Levodopa
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
04.09.01  Monoamine-oxidase-B inhibitors to top
Rasagiline
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Selegiline Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
04.09.01  Catachol-O-methyltransferase inhibitors
Entacapone
View adult BNF View SPC online View childrens BNF
First Choice
Amber

Specialist initiation

 
Opicapone (Ongentys®)
View adult BNF View SPC online View SMC online View childrens BNF
Restricted Drug Restricted
Amber

Specialist initiation only; second line COMT inhibitor for patients who clinically benefit from entacapone but experience intolerable associated side effects.

After specialist initiation, request to transfer opicapone prescribing to primary care is considered suitable once the patient’s treatment regime is stabilised.

 
 
04.09.01  Amantadine
Amantadine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
04.09.02  Antimuscarinic drugs used in parkinsonism
Orphenadrine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation.

 
 
Procyclidine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation.

 
 
Trihexyphenidyl Hydrochloride [benzhexol]
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
Haloperidol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Piracetam
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
Riluzole
View adult BNF View SPC online View childrens BNF
Formulary
Amber with Shared Care

In line with NICE TA20


GPs can prescribe where there is appropriate shared care arrangements in place.

 
Link  NICE TA20
 
Tetrabenazine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Specialist initiation

 
 
04.09.03  Torsion dystonias and other involuntary movements to top
Botulinum Toxin Type A (Xeomin®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Consultant use only including use in a patient pathway. See commissioning statement below.

Second line to local application of diltiazem for anal fissures.

 
Link  Herefordshire and Worcestershire CCG Botox Position Statement
 
Botulinum Toxin Type A (Botox®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

In line with NICE TA260. See commissioning statement below.

Second line to local application of diltiazem for anal fissures.

 
Link  Herefordshire and Worcestershire CCG Botox Position Statement
Link  NICE TA260 Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
 
Botulinum Toxin Type A (Dysport®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Consultant use only including use in a patient pathway. See commissioning statement below.

Second line to local application of diltiazem for anal fissures.

 
Link  Herefordshire and Worcestershire CCG Botox Position Statement
 
Botulinum Toxin Type B (NeuroBloc®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Consultant use only.


Only for use when Botulinum Type A is ineffective.

 
Link  Herefordshire and Worcestershire CCG Botox Position Statement
 
04.10  Drugs used in substance dependence
04.10  Alcohol dependence
04.10  Cigarette smoking
04.10  Opioid dependence
04.10.01  Alcohol dependence to top
Acamprosate Calcium
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.

 
 
Chlordiazepoxide Hydrochloride Tablets
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
 
Disulfiram
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
 
Nalmefene
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

In line with NICE TA325


Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
Link  NICE TA 325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
 
04.10.02  Nicotine dependence
Nicotine preparations (Nicorette Invisi®, Nicotinell®, NiQuitin® CQ)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

No behavioural support program associated with FP10 prescribing of NRT is currently available. Evidence shows a greater quit rate when smoking cessation products are combined with a support service.  GPs are therefore advised not to prescribe NRT on FP10. 


Refer all Herefordshire patients to Herefordshire Council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to NRT pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net


Worcestershire patients who are pregnant can access NRT pharmacotherapy & behavioural support, contact: 


wah-tr.smokingcessationteam@nhs.net for more information. 


 

 
 
04.10.03  Opioid dependence
04.10.03  Opioid substitution therapy
Controlled Drug Buprenorphine (Subutex®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

In Line With NICE TA114


Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
Link  NICE TA114
 
Controlled Drug Buprenorphine and Naloxone (Suboxone®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.

 
 
Controlled Drug Buprenorphine oral lyophilisate (Espranor®)
View adult BNF View SPC online View SMC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

NOT bioequivalent to buprenorphine sublingual tablets (e.g. Subutex®). 


Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


[Patients to be maintained on their normal brand if admitted as an inpatient - Contact Drug and Alcohol Services for further advice]

 
 
Controlled Drug Methadone Hydrochloride preparations
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

In Line With NICE TA114


Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.

 
Link  NICE TA114
 
04.10.03  Adjunctive therapy and symptomatic treatment
Lofexidine Hydrochloride
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
 
04.10.03  Opioid-receptor antagonists to top
Naloxone hydrochloride 1mg/mL (Prenoxad®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
 
Naltrexone Hydrochloride (Nalorex® & Opizone®, )
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber with Shared Care

In Line With NICE TA115


Prescribing by substance misuse specialists only. This includes GPs with appropriate training / competence who are contracted to provide substance misuse treatment on a shared care basis via a Locally Enhanced Service agreement between GP practices and the substance misuse specialist service provider.


 

 
Link  NICE TA115
 
04.11  Drugs for dementia
Donepezil Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In Line With NICE TA217 (Replaces TA19 and TA111)
 

 
Link  NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
Galantamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In Line With NICE TA217
 Preferred brand GATALIN XL

 
Link  MHRA Drug Safety Update (Dec 2015): Galantamine hydrobromide (Reminyl®): risk of serious skin reactions
Link  NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
Memantine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In line with NICE TA 217 (Replaces TA111)

 
Link  NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
Rivastigmine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In Line With NICE TA 217 (Replaces TA19 and TA111)
 
Preferred brand for 4.6mg & 9.5mg patches is ALZEST

 
Link  NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
 ....
 Non Formulary Items
Bupropion Hydrochloride  (Zyban®)

View adult BNF View SPC online View childrens BNF
Non Formulary

No behavioural support program associated with FP10 prescribing of varenicline or bupropion is currently available. Evidence shows a greater quit rate when smoking cessation products are combined with a support service.  GPs are therefore advised not to prescribe bupropion or varenicline on FP10. 

Co-proxamol (paracetamol 325mg, dextropropoxyphene 32.5mg)

View adult BNF View SPC online View childrens BNF
Non Formulary

In line with NHSE guidance the use of co-proxamol (paracetamol 325mg, dextropropoxyphene 32.5mg) tablets is not supported.



Patients currently prescribed Co-proxamol should be reviewed and assessed for suitability for switching to alternative analgesics.


 

Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
Dosulepin Hydrochloride

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
E-cigarettes  (Voke®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Prescribing of E-cigarettes is not currently recommended.
E-cigarettes will not be routinely funded within Herefordshire or Worcestershire as:
• There is insufficient evidence of benefit over and above existing smoking cessation products to support funding of E-cigarettes in the absence of behavioural support and it would be inequitable to do so when other forms of nicotine replacement therapy (NRT) are not funded; at the current time this recommendation should apply to all available e-cigarettes.
This is an evolving field that will be monitored for developments which may strengthen or weaken the recommendations for future funding.

Liraglutide  (Saxenda®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Controlled Drug  Targinact (oxycodone/naloxone)  (Targinact®)

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Non Formulary

The use of Targinact® (oxycodone/naloxone) modified release tablets for the treatment of severe pain is not supported.
No new patients should be initiated on Targinact® for the treatment pain.

Patients currently prescribed Targinact® for the treatment of pain should be reviewed and assessed for suitability for switching to Zomorph® (modified-release morphine sulphate) with additional laxatives. If Zomorph® is not suitable then then they should be switched to Longtec® (modified release oxycodone), with additional laxatives.

Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
Tramadol hydrochloride and paracetamol  (Tramacet®)

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Non Formulary

The use of Tramacet® or its generic equivalent (paracetamol 325mg, tramadol hydrochloride 37.5mg) tablets is not supported.
No new patients should be prescribed Tramacet® or its generic equivalent (paracetamol 325mg, tramadol hydrochloride 37.5mg).

Patients currently prescribed Tramacet® or its generic equivalent (paracetamol 325mg, tramadol hydrochloride 37.5mg) should be reviewed and assessed for suitability for switching to alternative analgesics.

Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
Varenicline  (Champix®)

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Non Formulary

No behavioural support program associated with FP10 prescribing of varenicline or bupropion is currently available. Evidence shows a greater quit rate when smoking cessation products are combined with a support service.  GPs are therefore advised not to prescribe bupropion or varenicline on FP10. 

  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Secondary care only, not to be prescribed in primary care.   

Amber 2

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber with Shared Care

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber

Considered suitable for primary care prescribing following specialist initiation/recommendation.  

Green

Considered appropriate for prescribing in both secondary and primary care. Suitable for initiation in primary care.   

netFormulary